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3 Sexuality I think’ he replied ‘ it is here to stay’ Groucho Marx on Sex After people are clothed and fed, then they think about sex. K’ung Fu-Tzu (Confucius) 551-479 BC

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Leonard Consultancy - Scotland Nota 20144 Sexual Health Integration of the somatic, emotional, intellectual and social aspects of A sexual being in ways that are positively enriching and enhance personality, communication and love. (conveys being alive and human) WHO 1975

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6 Sexuality – what’s normal to know what is deviant Gender similarities / differences Impact of age on sexuality Impact of medication/illness on sexuality Psychosexual dysfunctions What do we need to know?

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10 Perceptions of sexual behaviour – Normal? Perceptions of sexual behaviour – Normal? Sex when young………………..wrong Sex when old …………………doesn’t happen Sex when ill, disabled etc ………..harmful So when is it the right time?

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14 Four overlapping phases make sexual function: 1. Drive 2. Arousal – marked by erection 3. Release – orgasm and ejaculation 4. Resolution – degree of refractoriness therefore biopsychosocial process With offenders these 4 phases should also be considered in interviewing and analysis of offending

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Leonard Consultancy - Scotland Nota 201415 Research undertaken with 1065 women and 447 men attending General Practices. Results; 97 men and 422 women received at least one ICD-10 diagnosis. The most common problems were: erectile failure and lack or loss of sexual desire in men lack or loss of sexual desire and failure of orgasmic response in women. Increasing age and being unemployed predicted sexual problems in women, bisexual orientation, being non-white, and being unemployed were demographic predictors in men. The main clinical predictors were poor physical function and dissatisfaction with current sex life in both sexes and higher psychological morbidity in women, increasing age, sexual dissatisfaction Normal sexual behaviour?

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Leonard Consultancy - Scotland Nota 201416 Normal sexual behaviour Normal sexual behaviour ? 2/3 of participants reported sexual intercourse in the preceding month. Men were significantly more likely than women to report having masturbated and to express satisfaction with their sex life. Of the 139 (32%) men who did not report sexual intercourse, 81 (58%) had masturbated and 17 (12%) had received oral sex in the preceding four weeks. Of the 357 (34%) women who did not report sexual intercourse in the preceding four weeks, 108 (30%) had masturbated and 18 (5%) had received oral sex in the preceding four weeks. People who had not had sexual intercourse were much more likely to be dissatisfied with their sex life than the remainder.

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Leonard Consultancy - Scotland Nota 2014 Lowenstein (1996) noted the significance of visceral states (including heightened sexual arousal) on decision making and suggested that such heightened states can impact decision making in 3 broad ways 1.Narrow attention to factors related to that state 2.Reduce time horizons, focusing on short term factors 3.Narrow focus of attention inwards, where the individuals own needs gain primacy over other decisional factors. Impact on risk taking behaviour. 24

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Leonard Consultancy - Scotland Nota 2014 ‘ erotic plasticity’ refers to the extent to which sexual drive can be shaped by social, cultural and situational factors i.e low plasticity – sex drive inflexible, independent of circumstances and suggests strong biological programming i.e high plasticity- entails the capacity to change and adapt High plasticity means individuals are able to change their sexual patterns and preferences as they move through adult life 25 Sex Drive

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Wives tend to change and adjust sexually over the course of marriage more than men do (Ard 1977) and that women are more likely than men to add new sexual activities Later in life ( Adams and Turner 1985). A man’s sexual tastes appear to be fairly well set by adulthood but a woman’s may change significantly Eg women more likely to switch back and forth re sexual orientation than men Baumeister 2004 IMPACT ON CHANGE 26 Leonard Consultancy - Scotland Nota 2014

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Leonard Consultancy - Scotland Nota 201428 Age related changes in sexual functioning Male sexuality peaks sharply around 17 years of age and then gradually declines Females do not reach their full sexual potential until their late 30’s or early 40’s and then they slow down to a lesser degree than men.

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Leonard Consultancy - Scotland Nota 201429 Potency and the Aging Process Belief that sex is among first biological functions to fall to the aging process – myth. Sexuality among last of facilities to decline with maturity Elderly people are still having enjoyable sexual experiences – although some may not remember the name of their partner!

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Age and Sexual Functioning Age and Sexual Functioning 1.Starr & Weiner 1981 – 800 adults - age range from 60 -91 years 68% men and 36% women still have sexual intercourse 2. Brecher (1984) Largest study of 4000 men and women aged 50 and over 50% men and women aged over 70 sexually active 60% men and 40% women still had sexual intercourse 30 Leonard Consultancy - Scotland Nota 2014

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3. Bretschneider and Mc Coy (1988) 100 men and 102 women aged 80-102 Majority said had active sex Affectionate, and intimate with someone of opposite sex at least once a year Mutual caressing 82% men, 64% women Masturbation 72% men, 40% women Penetration 63% men and 30% women 4. Mulligan and Moss (1991) 1031 war veterans aged 30-99 Sexual interest remained present but diminished with age Frequency of penetration from once weekly 30 -39 year olds to once a year 90- 99 Sexual activity may depend more on availability of sexually functioning partner Age and Sexual Functioning 31

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Leonard Consultancy - Scotland Nota 201436 Paraphilia ( cont) 2. Abnormalities in preference of sexual ‘object’ Preference for something other than another adult person in achievement of sexual excitement. ‘Object’ may be inanimate as in fetishist transvestism a child as in paedophilia an animal as in zoophilia dead person as in necrophilia

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Leonard Consultancy - Scotland Nota 201439 Normal population sexual dysfunctions Between May 1999 and February 2001 of 11161 men and women aged 16-44 years resident in Britain. The response rate was 65.4%. A total of 34.8% of men and 53.8% of women who had at least one heterosexual partner in the previous year reported at least one sexual problem lasting at least one month during this period. The most common problems among men were lacking interest in sex, premature orgasm and anxiety about performance; and among women, lack of interest, inability to experience orgasm and painful intercourse

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Leonard Consultancy44 Impact on staff working with issues of sexuality Working with sexuality whether from an abuse or Dysfunction perspective will for the worker create ‘ encounters with self and sexuality that prove rewarding enlightening and liberating, but it may for some reveal aspects of our own sexual development and sexual values which are unresolved.’ Morrison 1997

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Leonard Consultancy45 an inability to talk to partners about sex, about work or about the connections between the two sexual dysfunctions, including arousal problems and a a lack of interest in sex a heightening of the importance of sex in personal or friendship relationships, or self soothing over – sensitive to sex Sexual Impact Issues